Dr. Mark Hyman is famous as the “founder” of a form of woo known as “functional medicine.” This new form of woo is…well, I’m not sure what it is, and neither are Wally Sampson (1, 2, 3, 4). Suffice it to say that it appears to be a serious grab bag of various forms of woo that, according to Dr. Hyman’s website itself, involve environmental inputs, inflammation, hormones, gut & digestive health, detoxification, energy/mitochondria/oxidative stress, and, of course, “mind-body,” whatever that means. No woo would be complete without mind-body, you know. Actually, no self-respecting woo would leave out “detoxification,” either.

In the meantime, Dr. Hyman has popped up on the one web commentary outlet where he should truly feel at home, namely The Huffington Post.
How do I know this? Easy. A whole bunch of you sent me the link to a truly execrable article that appeared on HuffPo on Saturday entitled Why Current Thinking About Autism Is Completely Wrong. Damn it! I was trying to take the weekend (mostly) off from blogging, with some previously written stuff scheduled to post, and here you all were, trying to tempt me back. Fortunately, my will held strong, and I managed to delay writing anything about this quacktastic woo-fest until last night.

Two days haven’t made me feel any more merciful towards it.

That’s especially true because Dr. Hyman’s HuffPo article is virtually identical to an article he wrote almost two years ago for his Ultrawellness Blog, entitled–surprise! surprise!–Why Current Thinking about Autism is Completely Wrong. Indeed, there’s even a video:

Recycled material on HuffPo? Who’da thunk it? I doubt HuffPo will care much, though. after all, if the editors there don’t give a rodent’s posterior about the medical accuracy of the anti-vaccine line that bloggers there so regularly lay down, I doubt that a little thing like republishing a two year old post would bother them. At least I label my repeats as being repeats.

“Autism is caused by poor mothering.” That was the belief of the medical community until the late 1960s.

“Autism is a genetic brain disorder.” That is what most people — and most of the medical community — believe today.

I’m here to tell you that neither one of these statements is true.

Think about it. Rates of autism have skyrocketed over the years, from an estimated 1 child in 3,000 to just 1 in 150 kids today. Sure, wider criteria for diagnosis and better detection might explain some of it — but not an increase of this magnitude.

How many times have I been over this issue before? Apparently Dr. Hyman clearly doesn’t understand the confluence of factors, including the marked broadening of the diagnostic criteria for autism in 1994, increased awareness, and, of course, increased screening. Diagnostic substitution has a lot to do with it, of course. Also, although it is controversial whether the incidence of autism has increased over the last couple of decades, it is not controversial that the real rate of autism hasn’t increased by nearly as much as it appears to have increased. True, the apparent rate of autism appears to have increased dramatically over the last 20 years, but careful studies that have been done suggest that we are moving towards a new consensus prevalence of autism and autism spectrum disorders of around 1% and that autism prevalence, if it has changed over the last few decades, has not changed by anything even close to 200-fold. Indeed, the National Autistic Society explains the discrepancy well, pointing out areas of uncertainty and referring to the example of Tourette’s disorder, which is 1,000 times more common than had previously been thought. That’s nothing compared to Hyman’s figures, which, if correct, would suggest that that autism is “only” 20 times more common than previously thought.

It’s also quite clear that Hyman is pulling the old “science was wrong before” gambit. Skeptico, John Jackson, and I have discussed why this is a dubious gambit beloved of advocates of pseudoscience. The CliffsNotes version is that, just because science may have been wrong in the past does not mean that Dr. Hyman is correct now.

Dramatic scientific discoveries have taken place during the last 10 to 20 years that reveal the true causes of autism — and turn conventional thinking on its head. For example, Martha Herbert, MD, a pediatric neurologist from Harvard Medical School has painted a picture of autism that shows how core abnormalities in body systems like immunity, gut function, and detoxification play a central role in causing the behavioral and mood symptoms of autism.

She’s also given us a new way of looking at mental disease (and disease in general) that is based on systems biology. Coming from the halls of the most conservative medical institution in the world, this is a call so loud and clear that it shatters our normal way of looking at things.

Everything is connected, Dr. Herbert says. The fact that these kids have smelly bowel movements, bloated bellies, frequent colds and ear infections, and dry skin is not just a coincidence that has nothing to do with their brain function. It is central to why they are sick in the first place! Yet conventional medicine often ignores this.

Dr. Herbert’s work shows nothing of the sort. Go ahead. Head over to PubMed and look at Dr. Herbert’s publication record. I’ll wait. She has listed 15 publications about autism, of which:

six are review articles

two are in alt-med journals, and one of these is an interview

one is a paper with dozens of authors reporting the results of mapping autism risk loci using genetic linkage and chromosomal rearrangements. (Dr. Herbert is solidly right in the middle of the huge pack of authors.)

Of the remainder, Dr. Herbert only appears to be first author or senior author on four publications on autism containing original research, and these appear to be all imaging studies of the brains of autistic children. In other words, Dr. Herbert is making claims far beyond what her publication record in the peer-reviewed literature can, even under the most charitable interpretation possible, support. Nothing at all in her publication record appears to support the concepts above of autism being a systemic, rather than brain-based condition. There’s nothing about systems biology there (and I actually rather like systems biology); nothing there to support a link between autism and gut disorders; nothing to support a link between autism and immune dysfunction; and nothing to support a link between “environmental influences” and autism. That’s not to say that there aren’t environmental factors that influence the development of autism; it’s just that there’s nothing in Dr. Herbert’s publication record to support such a hypothesis or to identify what, if anything, those environmental factors might be.

In other words, there is nothing at all to support Dr. Hyman’s claims, which appear to be based on Dr. Herbert’s claims. Certainly, there’s nothing there to support the grandiose claims that Dr. Hyman makes. Not that that stops Dr. Hyman from pulling the Galileo gambit:

My friend and mentor, Sidney Baker, MD — a pioneer in the treatment of autism as a body disorder that affects the brain — often says, “Do you see what you believe or do you believe what you see?”

The problem in medicine is we are so stuck in seeing what we believe that we often ignore what is right in front of us because it doesn’t fit our belief system. Nowhere is this true more than in the treatment of autism.

Such a criticism may be at least partially true of scientific medicine at times, but not in the way that Hyman apparently means, and in this case Dr. Hyman can’t produce one whit of evidence to persuade me that it is true for autism. Perhaps it never occurred to Dr. Hyman that the reason his belief system is not taken seriously by autism scientists is because there’s no credible scientific evidence to support it. But, boy, oh, boy does Dr. Hyman have anecdotes. Actually, strike that. It’s not plural. He has a single anecdote, an “N of 1,” if you will.

Dr. Hyman sets the stage:

He received diphtheria, tetanus, whooping cough, measles, mumps and rubella, chicken pox, hepatitis A and B, influenza, pneumonia, hemophilous, and meningitis vaccines — all before he was 2 years old. Then something changed.

He lost his language abilities and became detached. He was unable to relate in normal ways with his parents and other children. And he became withdrawn, and less interactive. These are all signs of autism.

Sam was taken to the best doctors in New York and “pronounced” as having autism, as if it were a thing you catch like a bug. His parents were told that nothing could be done except arduously painful and barely effective behavioral and occupational therapy techniques. The progress would be slow, and his parents should keep their expectations low, the doctor said. Devastated, the mother began to seek other options and found her way to me. While we have just started working together, the results in only a few weeks have been remarkable.

Note the clever way this story is told. Dr. Hyman doesn’t explicitly blame vaccines, but he makes a very definite point of mentioning that the child received his vaccines…and then “something changed.” No mention of the time course is given. Did this change occur right after vaccination, or did it occur weeks or months later? Who knows? Even if it occurred weeks or months later, the implication is still there: The vaccines done it!

Then there’s the very same structure to the story that we often see in alt-med testimonials. Rejected by conventional medicine. No hope. Then began the search, and, at the end, the savior is found and that savior is Dr. Hyman, who diligently subjected the child to a hole heapin’ helpin’ of woo. None of this “biomedical” woo was based on any clear science. In fact, it’s a hodge-podge–a grab bag, if you will–of remedies based on metabolic tests finding alleged gluten allergies, amino acid abnormalities, methylation abnormalities, various nutritional deficiencies. These remedies included:

Step 1: Fix His Gut and Cool the Inflammation There

This step included a number of different tactics including:

Taking away gluten and other food allergens

Getting rid of his yeast with anti-fungals

Killing off the toxic bacteria in his small intestine with special antibiotics

Replenishing healthy bacteria with probiotics

Helping him digest his food with enzymes

Step 2: Replace the Missing Nutrients to Help His Genes Work Better

In Sam’s case we:

Added back zinc, magnesium, folate, and vitamins A, B6, B12, and D

Supported his brain with omega-3 fats

Step 3: Detoxify and Reduce Oxidative Stress

Once his biochemistry and nutrition was tuned up, we helped him detoxify and reduce oxidative stress.

Well, actually, yes, this does sound very familiar. Woo-meisters the world over love “detoxification” of unknown and unnamed “toxins” that are supposedly the cause of all disease, all accompanied by a boatload of various supplements.

Dr. Hyman is the protoypical brave maverick doctor who don’t need no steekin’ randomized controlled studies to tell him what works. It matters not one bit to him that autism is a condition of developmental delay, not developmental stasis. Autistic children do develop, regardless of what treatments they are subjected to, but the assumption n is all too often that these children don’t develop, which leads “brave maverick doctors” like Dr. Hyman to attribute any improvement they observe in an autistic child to whatever the woo du jour to which they happen to be subjecting the child at the time. The thought of a randomized clinical trial never enters their mind because they know this stuff works. They’ve seen it. Never mind that without a proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children there’s no way of knowing if any improvement observed in Sam was due to any of the woo to which he was being subjected or just natural aging and development. Indeed, there is evidence that as many as 19% of autistic children move “off the spectrum” by their 7th birthday. Indeed some “recover” spontaneously. With an N of 1, we have no idea if Sam is just such a child. One wonders whether Dr. Hyman will ever publish his “recovery” rate for autism based on a large number of children.

Somehow I doubt it.

How do I know this? Easy. Dr. Hyman concludes with these appeals:

Every child with behavior problems, ADHD, or autism is unique — and each has to find his or her own path with a trained doctor. But the gates are open and the wide road of healing is in front of you. You simply have to take the first step.

Please visit the Defeat Autism Now! website for more information on this subject, including resources and conferences for doctors and parents.

Yes! An appeal to visit the quack site of all autism quack sites, coupled with an appeal to sign up for Dr. Hyman’s newsletter and (eventually, I’d guess) later appeals to buy his stuff. What else would we expect?

The truly depressing part of this whole thing is that Dr. Hyman is actually taken seriously as an “expert” in “wellness” and “alternative” medicine. Not only that, but he’s much sought after as a speaker, and, as I mentioned before, has testified and spoken at the very highest levels of government as though anything he has to say on “wellness” should have any bearing on any health care reform legislation that may be passed this year.

That’s how far woo has infiltrated not only academic medicine, but our government as well.

136 Comments

Senate testimony has a record of pandering to whatever the more powerful senators want to hear. When Delay, Rohrabacher, Inhofe, Doolittle, … and co. were in power, climate science was obtained from fiction writer, economists, and wishful thinking from whoever would give the answers the senate (and house) powers wanted to hear.

In Kansas, when they were having their Kangaroo Court regarding evolution, they imported a Turkish terrorist to testify on their (antiscience) behalf.

I’m sorry, but I just couldn’t get past this steaming pile of ignorance.

If this were true, and I followed the protocol, I would expect my kid to be EVEN MORE autistic. We have at least 4 family members with AS. Just imagine if my kid’s genes ‘worked better’. Forget Asperger’s, my son would be Rainman.

I’m no statistician, but it seems to me an increase from 1/3000 to 1/150 is only 20-fold, not 200.
Otherwise a great post and yet another face and name to watch out for. He’s got a good sincere manner and no doubt a lot of worried parents will swallow the whole story without much question

The problem in medicine is we are so stuck in seeing what we believe that we often ignore what is right in front of us because it doesn’t fit our belief system. Nowhere is this true more than in the treatment of autism.

Having been on both an antibiotic and an antifungal at the same time (I got a sinus infection while doing a course of Lamisil for fungal toenails), dear god, what a miserable thing to do to a little kid! (And talk about GI upsets.) The side effects of those kinds of drugs are bad enough if you’re an adult and doing it voluntarily, never mind if you’re a little kid with communicative difficulties. The regimen described is, IMO, bordering on child abuse.

I’d say I felt sorry for the parents for having to deal with a miserable kid for that long, but the parents really have only themselves to blame.

What do you call a bunch of quacks calling someone else a quack? Right….hypocrisy.

Ahh, the old I-know-you-are-but-what-am-I defence; cunning. With that out of the way, would you now like to take a shot at defending Hyman’s claims with some (dare to dream) evidence? You know, actually demonstrate that he isn’t the complete and utter quack he appears to be.

He received diphtheria, tetanus, whooping cough, measles, mumps and rubella, chicken pox, hepatitis A and B, influenza, pneumonia, hemophilous, and meningitis vaccines — all before he was 2 years old. Then something changed.

I’m reminded of Peter Griffin…

“Oh no, I knew a guy who bought a used car from the newspaper once. 10 years later? Bam! Herpes.”

He received diphtheria, tetanus, whooping cough, measles, mumps and rubella, chicken pox, hepatitis A and B, influenza, pneumonia, hemophilous, and meningitis vaccines — all before he was 2 years old. Then something changed.

Pablo said: The first DTaP and HIB are given at 2 months. Suddenly, two years later, BAM! Autism.

I’ve seen moms that claim vaccine injury years after the shots. Some even claim decades. Then they blame the doctor for not giving their theory the time of day. Of course, the same idiots complain about doctors not offering “alternative remedies” like homeopathy.

It must be nice to have a convenient boogeyman on which to blame all that ails you.

Gee, I must remember to remind my son that he should NOT be extremely physically healthy (as he is). He’s autistic, so he should have all these serious health issues that supposedly cause autism. Then I could cure him, right?

So mumkeepingsane, are you saying that your son does NOT have especially stinky poo?

The fact that these kids have smelly bowel movements, bloated bellies, frequent colds and ear infections, and dry skin is not just a coincidence that has nothing to do with their brain function. It is central to why they are sick in the first place! Yet conventional medicine often ignores this.

“Never mind that without a proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children there’s no way of knowing if any improvement observed in Sam was due to any of the woo to which he was being subjected or just natural aging and development.”

Risperdal went through a “proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children,” didn’t stop it from growing milk-producing breasts on boys.

Paul – I read the life story of Dr. Hyman that you linked to: omigod, this is truly shocking! What a weird, creepy story. I wouldn’t see this man for a hangnail. I’d like to have a chat with the two doctor’s wives who “ran him out” of Idaho!

Jake Crosby @ 23: “Never mind that without a proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children there’s no way of knowing if any improvement observed in Sam was due to any of the woo to which he was being subjected or just natural aging and development.”

Risperdal went through a “proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children,” didn’t stop it from growing milk-producing breasts on boys.

I’ll take non-sequitors for $300, Alex.
I’m sorry, what does antipsychotic-induced hyperprolactinemia have to do with the claims of Dr. Hyman?

Dr Jay, you may be right regarding the typo, as a gunman properly sights a target. However, Orac could be warning us all that he is turning his sites (RI and SBM) on Ultrawellness. Certainly this topic would be appropriate at the other blog site also.

Dr. Jay may not be aware of my extreme distaste for pedantry, particularly pedantry in the form of comments that consist of nothing more than a typo or spelling flame and have no substantive commentary associated with them. Indeed, as regular readers may know, I have a tendency, depending on my mood, to delete such comments with extreme prejudice.

Uh-oh, that’s a grammatically deficient sentence, desperately in need of a verb. Dr. Jay has to go to the back of the class, mindful of the frequency with which grammar-naggers commit violations in their own attempts at correction.

Dr. Jay and Dr. Hyman actually have a lot in common. They both preen with regards to their “maverick” status and lack a basic understanding of evidence-based medicine, preferring to dwell on anecdotes and subjective experience.

We could use a Hall of Shame website for all of these antivax, self-promoting embarassments to the medical profession.

But, there was substance in my saying that many people, myself included, disagree with Dr. Hyman.

Good for you. Now, what are you going to do about it?

Will you write a rebuttal to the Huff Post? The next time you get to a anti-vax rally (whatever fluff name they are given), will you speak out against such whackery? Or will you sit back and let him go unchecked because you know that were you to speak out against him, you will lose some of your status as the anti-vaxxers favorite doctor? You might even get lumped in with the evil vaccinationists!

Bacon! It’s been a while since you’ve aimed your unpleasant hyperbole at me. The wounds have healed sufficiently for you to resume. I truly enjoy your posts when they’re factual and educational in nature and I’m never quite sure why you resort to being nasty. You don’t need to.

Pablo, good idea. I will work on a rebuttal after work tonight. By the way, I sincerely doubt that I’m the favorite doctor for the anti-vaccine camp because I give shots in my office. Hard to be “anti-vaccine” and give shots, too!

Fine job, there, Dr Orac! My best bud Louise and I did a couple articles over at our blog about functional dumbasses and a dumbass rodeo concerning this woo-doctor thinkin that folks had broken brains. He sure does think they got broken brains and ain’t capable of thinkin straight. Oooh boy, he’s abankin on that so he can take their money.

His parents were told that nothing could be done except arduously painful and barely effective behavioral and occupational therapy techniques.

Wow… arduously painful? My son quite enjoyed his behavioral and occupational therapy, what with all the swinging and playing of games – especially as he was rewarded for participation with Skittles. I had no idea the tot was such a masochist.

Barely effective? My son was nearly four and both completely non-verbal and prone to violent/self-injurious outbursts when we began ABA therapy. Just over three months later he spoke his first self-initiated sentence. (“Bye Mom, I love you” – MAJOR tear jerker, that one.) Within 6 months his self-injurious behaviors were a thing of the past.

Now 10, my son is healthy and happy. He has friends and will talk non-stop about a number of fond subjects. He’s behind academically, certainly, but he loves science and is learning to read.

Luckily I understand, more so than Dr. Hyman apparently, that personal experience doesn’t trump sound science so I would never claim that all Autists will respond as well to ABA as my son did – but one good turn of subjective experience deserves another don’t you think?

This doctor claims on his “ultra super duper fabo brain book” site that people ar suffering from “enflamed brains” and that they feel nothing..Nothing that is but “depressed, unfocused-or worse autistic or demented” How does one go about feeling demented?

“Dr. Mark Hyman is famous as the “founder” of a form of woo known as “functional medicine.” This new form of woo is…well, I’m not sure what it is…”

Dr. Hyman is merely a leading proponent of FM, not its founder.

I like John Neustadt’s definition of functional medicine. it is clear and succinct. It strikes me as a sensible way of viewing many diseases (and how to deal with them):

“In many cases, the underlying causes of disease are biochemical in nature. Biochemistry is how the body uses vitamins, minerals, fats and proteins to do its job, and how things like infections, allergies and environmental toxins interfere with proper biochemistry to cause symptoms and disease. In other words, if you weren’t sick last year or last month, and you are now, something has changed in your biochemistry. Determining where a person’s biochemistry has gone haywire and then correcting it through targeted nutritional therapies is called medical biochemistry or functional medicine.”

While it is true that your anecdote about the efficacy of ABA is not all that useful (aside from being a counter-point to the “barely effective” assertion), your insight into how “arduously painful” it isn’t is extremely relevant. I need to calibrate my Bullshit meter a little better, because that should have set it off.

As far as I can deduce, abusive methods are not currently in favor in ABA, are they? I think I have heard claims that there were some places that had used them at one time, but, jeez, no one in their caring mind is going to knowingly allow such to go on (what’s next, shock therapy?) However, an affirmative approach that rewards progress (Skittles!) wouldn’t be a problem. I can’t believe that the case mentioned couldn’t find such an opportunity among all the experts in New York…

“Bacon! It’s been a while since you’ve aimed your unpleasant hyperbole at me. The wounds have healed sufficiently for you to resume. I truly enjoy your posts when they’re factual and educational in nature and I’m never quite sure why you resort to being nasty.”

I’ve never quite understood the lack of self-awareness that allows Dr. Jay to substitute nastiness for responsiveness in his own posts (such as insinuating that contributors to this blog are paid off by Big Pharma, as well as the snide comments made in his earlier posts to this thread) while castigating others for being meanies. Perhaps the word I’m looking for is “hypocrisy”.

“However, an affirmative approach that rewards progress (Skittles!) wouldn’t be a problem.”

I really hate to see ABA’s using skittles, m&m’s, etc. as a reinforcer, since FD&C food colorings have been linked to behavior problems in children. Kinda defeats the purpose of ABA. ::shrug:: Not to mention the effects on dental health.

Keep us posted on that rebuttal, Jay. I’m sure we’re all looking forward to reading it.

Jake Crosby, what Risperdal is or isn’t has nothing to do with the fact that bringing it up is a non sequitur that adds nothing to the conversation. The fact that it has nothing to do with this discussion is what makes it a non sequitur.

Charlotte,
Peter Szatmari, in his book, A Mind Apart: Understanding Children with Autism and Asperger Syndrome, suggests that there have always been reports of improvement and recovery. he cites Kanner from 1972 reporting on the first 96 patients he saw with autism.In adulthood 11 were functioning gainfully in society despite continuing problems with intimate adult relationships. Szatmari suggests that according to his own data 20 per cent of adults with aspergers and 10 per cent with autism progress to the point were they score in the average range for social and communication skills and have few if any clinical symptoms of autism.

There is very little research into adult outcomes. Anecdotally, the autistic adults that I know via the National Autistic Society could all be said to function gainfully but are still recognizably autistic. We also do not know how many “recovered” autistics are, as Liane Holliday Willey put it in the title to her autobiography, Pretending to Be Normal while retaining their autistic neurology. One autistic adult in the USA described himself as an Apple computer running a PC emulator which sometimes crashed.

Riiiight. You bring up a side effect of a specific drug on a thread about the claims of a quackery-pushing doc because…? I still don’t see how it relates. That is, it’s unequivocably a non-sequitor argument.

Oh, we all see what your getting at: Look I found perceived failure of a single product of so-called Evidence-Based Medicine, thus I have disproved the usefulness of Evidence-Based Medicine and simultaneously proved the usefulness of my own favored approach(es)! Except…it doesn’t. It makes you look as stupid a H*ppeh.

As far as I can deduce, abusive methods are not currently in favor in ABA, are they?

Absolutely not. There was a time when negative reinforcement was fairly common among ABA practitioners, but it has long since been abandoned by sane therapists – not only out of a sense of decency, but also because negative reinforcement almost always increases stimming behaviors. Unfortunately, there will always be those who resort to abusive tactics but they’re far from the norm.

@Jen

I really hate to see ABA’s using skittles, m&m’s, etc. as a reinforcer, since FD&C food colorings have been linked to behavior problems in children. Kinda defeats the purpose of ABA. ::shrug:: Not to mention the effects on dental health.

First of all, I would like to make it clear that it was my choice to use Skittles as my son’s most common positive reinforcement, not his therapist’s. While some studies have linked food colorings to hyperactivity, the link hasn’t yet been proven conclusively. Regardless, I tested several food rewards before settling on Skittles by documenting both his desire for the reward and any behavioral effects, then narrowing the options and increasing the amount given until I was sure they wouldn’t cause any issues. For my son, Skittles caused no increase in hyperactivity, no decrease in attention span, and had the added side effect of “teaching” him to tolerate chewy foods which had previously been declined.

As to his dental health – we did brush his teeth. Also, food rewards of any kind are usually intended only for short term use – typically being replaced by more complex rewards as part of therapy. We now use a combination of sticker charts at school which are traded for science experiments and pennies at home which are traded for weekly allowance.

I was hoping for something a little more rigorous, but that’s a start. I know that most autistic spectrum adults “function gainfully” (couldn’t think of a better way to put it than yours!) but 7 seems rather young for pretending to be normal and learning to conform with social norms, hence my interest.

Also, 7 is so early that kids who are functioning in the ‘normal’ range by then wouldn’t have made it into the statistics at all until recently (in the UK). I assume they’d also be much less likely to join organisations like the National Autistic Society even if diagnosed, so they may disappear from the conversation a bit.

With that intellectual lead in you shovel the usual drivel that any rise in autism diagnoses can be explained by the change in diagnostic definition dating back to 1993-4, and other social factors?

Not only are you silly but you are also out of date. Even the IACC has acknowledged the need to start funding research of the potential environmental causes of autism. As Professor Simon Baron Cohen has stated publicly on at least 3 occasions given that in some cases where one identical twin has autism the other does not indicates that autism likely a result of an interaction of genetic, environmental and biological factors. Of course he did not explain his position using scientific terminology like woo and quack so what does he know?

As you know Harold, Autism is genetic, but to what degree other factors play a role is unknown. Your small-minded band can cherry pick quotes all you like but it doesn’t make evidence for your pet hypothesis.

Jake bleated, “The drug grew breasts on boys” Wait, are we talking about the Lupron-Autism Quackery? While it doesn’t negate its potential as a tool for psychiatrists, Risperdal has weight gain issues for many, period. Moobs is what happens when someone gets fat.

Jake, you’re spending a good bit of time slinging mud here – a place you hate. Might I suggest you take a good hard look at the lies your parents told you about you being poisoned by the government and really think things through; you’re not damaged goods and you’re not broken. You are different. And that’s ok. What’s not so ok is that you are also a laughably under-educated asshole.

@”Edumacation”: Let’s stick to treatments used for autism. Do you know of any other than Risperdal which has also been shown to grow milk-producing breasts on boys?

@”Orac”:

“Dr. Herbert is making claims far beyond what her publication record in the peer-reviewed literature can, even under the most charitable interpretation possible, support. Nothing at all in her publication record appears to support the concepts above of autism being a systemic, rather than brain-based condition. There’s nothing about systems biology there.”

-You are wrong:

“This convergence of findings and models suggests that a systems- and chronic disease-based reformulation of function and pathophysiology in autism needs to be considered, and it opens the possibility for new treatment targets.”

Risperdal went through a “proper scientific randomized, double-blind, placebo-controlled clinical trial with a large number of children,” didn’t stop it from growing milk-producing breasts on boys.

Since Jake didn’t get the drift of several previous commenters, let me be the one to spell it out in painful detail.

Risperidone (Risperdal) can cause some boys to “grow breasts” (gynecomastia) – this is true. It is called a “side effect”. It also happens to be effective at reducing some of the problematic behaviors of autism – as several placebo-controlled randomized studies have shown.

So, we have a drug that is shown to be effective – not at “curing” or “recovering” autism but at reducing the severity of problematic behaviors (such as aggression). It also has a side effect of mild to moderate gynecomastia in some boys.

This is how real medicines work, Jake. They have a desired effect (or effects) and also may have a number of undesirable side effects. Sometimes, these side effects are troublesome enough to make people stop taking the drug.

In contrast, fantasy medicines (like homeopathy and “energy medicine”) have no side effects – they also have no real effects.

In further contrast, we have “therapies” such as chelation for autism and Lupron “therapy” for autism that – while having no demonstrated real effects – have very real and sometimes serious (e.g. death) side effects.

So, Jake, what would you have us do? Treat with real medicines that have real studies supporting their use – even though they have well-documented side effects?

Or should we resort to fantasy treatments that have neither side effects nor real effects?

Or should we take the third path of using real medicines in ways that have not been shown to work, thus accepting the risk of side effects with little (or no) hope of real effects?

I see Harold is spamming again. We’ve got that Jake Crosby chap saying, well he’s saying something. Perhaps he’ll get round to telling us lot what it is rather than forcing us to guess like he usually does. Don’t hold your breath thou’ because “It’s ‘obvious'” and he’s “Tired of explaining it”.

“Even the IACC has acknowledged the need to start funding research of the potential environmental causes of autism.”

We know. And this relates to the claim that increased diagnosis of autism has been directly caused by an actual increase in what way?

“As Professor Simon Baron Cohen has stated publicly… …autism (is) likely a result of an interaction of genetic, environmental and biological factors”

We know. So tell us where he said “and the diagnostic increase is explained by increase in the environmental trigger”? Direct reference please.

BTW – here’s a quote from SBC, from the article you link to on your wellsphere page.

“This figure represents an increase over earlier ones but this rise is likely to be due to better diagnosis and awareness of the condition.”

So to recap:
Orac postulates that the diagnostic increase in autism is due (in part) to increases in social and clinical factors, perhaps unrelated to any real increase.

Harold disagrees with Orac because:

his first source (which talks about autism genetics and provides multiple references) mentions looking at environmental factors (with zero references), no mention (except in passing) that these environmental factors are involved in the aetiology of autism to the extent that they have caused the diagnostic increase. So, nothing directly related to Orac’s discussion of Dr Hyman there.

his second source has said the same as Orac except he disagrees a bit about the aetiology of autism. Currently no reference supplied that deals with what Orac actually said.

Is Harold even aware of what the opening post was actually about? If so – why didn’t he stay on topic? Why did he name-drop two sources that have nothing to do with Orac’s criticism of Dr Hyman?

That’s a review article. Scientists know that review articles are not original research, and when I as a scientist refer to Dr. Herbert’s publication record I am referring only to original scientific contributions, not review articles. I don’t expect you to know that, but this is the convention among scientists. It’s short hand. Original research articles in peer-reviewed scientific journals count. Review articles and editorials don’t.

My comment stands. Dr. Herbert has done nothing in her research/publication record to support her claims.

A good quality systematic review does not support the use of risperidone with autistics (Jesner et al., 2007). A more recent multi-site RCT involving developmentally disabled adults (including autistics) concludes that anti-psychotics, including risperidone, are not an acceptable treatment for this population (Tyrer et al., 2008).

Well excuse me for being such a lay-person about all this. Finally, you’ve managed to prove to me that you know something about this topic only other “scientists” would know, that when they refer to their publication record they only mean their research. While you’re at it, why don’t you tell me about the scientist’s secret hand-shake?

As for Dr. Herbert, even if there is nothing in her own research to support her claims, she still bases what she says off of original research, that’s what counts.

“There are a myriad of ways that good behaviors can be reinforced without the use of sugary, HFCS-containing coal-tar derivatives. ::eye roll:”

That’s nice. At the end of the day when parents of autistic children get into bed (that’s only if they are *allowed*, of course) and wonder “Could I have done anything more today to contribute to the therapy needs of my child?” there you will be to pass judgment on the sugar content of praise tools.
Way to be, there, you who obviously knows nothing about raising special needs children.

It is indeed. And what the evidence shows is that while risperidone can often alleviate some of the more disruptive symptoms of autism that can be an obstacle to educational and behavioral therapies, it also can produce some significant side effects, including hormonal effects, such that its benefits must be weighed against its risks on an individual basis. So did you have some sort of point, or are you simply belaboring the obvious point that genuinely effective treatments almost always carry some risk of adverse effects?

Not only are you silly but you are also out of date. Even the IACC has acknowledged the need to start funding research of the potential environmental causes of autism. As Professor Simon Baron Cohen has stated publicly on at least 3 occasions given that in some cases where one identical twin has autism the other does not indicates that autism likely a result of an interaction of genetic, environmental and biological factors.

Actually the twin concordance of autism is remarkably high. While autism is almost always shared by identical twins, the severity may vary. This is suggestive of an environmental influence, but that is not necessarily the case. After all, twins have fingerprints that are similar, but not exactly the same. And even identical twins may have genetic differences–epigenetic differences, differences in distribution of mutant mitochondria within the body, and differences in patterns of X-chromosome inactivation in girls. The latter accounts for variations in severity of Rett Syndrome, which is well established to have a genetic cause. Notably, Rett Syndrome commonly includes autistic-like symptoms, as well as apparent “regression.”

Nevertheless, an environmental influence remains a possibility. But it is hard to know where to start. While vaccines have been pretty clearly eliminated, children and pregnant women are exposed to a huge number of chemicals–pretty much every substance ever made or used by man can be found at some level in the human body. And then there is also the possibility that something like a viral infection could play a role. Perhaps once the genetic basis of autism is better elucidated, we will be in a better position to evaluate the impact of possible environmental factors.

A good quality systematic review does not support the use of risperidone with autistics (Jesner et al., 2007).

Actually, Jesner et al. did not come out definitively for or against risperidone. They state, “Some evidence of the benefits of risperidone in irritability, repetition and social withdrawal were apparent. These must however be considered against the adverse effects, the most prominent being weight gain.” They conclude that “Risperidone can be beneficial in some features of autism,” but that “Further research is necessary to determine the efficacy pf risperidone in clinical practice.”

I’d add that the latter statement applies to all drug treatments commonly used in autism. Risperidone actually has better evidence of efficacy than most.

Jesner et al. (2007) note many major limitations with the included RCTs (which were “few and small”), and write that what benefits there may be (which “must be interpreted cautiously”) have to be considered against important adverse effects.

Jesner et al. (2007) conclude that “carers and clinicians should be aware of the paucity of evidence in administering this drug in such a vulnerable group of people.” And: “it is impossible to evaluate the long term side effects and efficacy of risperidone, and this is particularly important.”

I don’t see statements like “paucity of evidence,” and so on, to be in support of administering risperidone to autistics.

Then stop emulating her. Perhaps you can seperate yourself from the legacy of Sue M. by posting with some intelligence, and here is a novel idea: evidence and facts. Not the usual fact free string of baseless insults which is a Sue M. trademark.

Because you keep changing your ‘nym, it is convenient to just know you as either Sue M., or just a Sue M. clone.

“Way to be, there, you who obviously knows nothing about raising special needs children.”

JR, I know plenty about raising special needs children, (since I have two boys on the autism spectrum) and I am also well aware of the deleterious effects that coal-tar derivatives have on their behavior, which is why I don’t allow my children to consume them.

@67 JR, nobody is passing judgement. Most people are just doing the best they can. Some children (like mine) cant handle even the slightest amount of food coloring, very little sugar, no detergents…and on and on. When they start itching within seconds of exposure to the offending ingredient, and then it progresses to hives, then areas of red peeling skin, you have to be very careful. Just because all kids dont react in such a visible organ like their skin, does not mean they arent reacting in another organ like their brain, liver, etc. You may not see it, but the damage may be happening. So, we are all learning as we go. Once you know better, you can make choices on the few things you actually have control over, and do better. No judgement.

Pablo, just a note, I must say from experience that all the behavior mofification in the world does not work when my autistic child is getting the dental work on those rotting teeth done. Actually, he withdraws more…stress, pain, anesthetic? dont know. Nightmare!

It is entirely possible that he’s become confused with “pneumococcal” — the bacterium is Streptococcus pneumoniae. My daughters were both vaccinated against that, via Prevnar. It’s one of the routinely recommended vaccinations, given to small children. It’s a good idea, too, but it may confuse those who don’t know what they’re talking about.

Regarding Risperdal as some sort of evidence against science-based medicine, I’d like to point out that science is what revealed that it has these adverse side effects. If it had not been subjected to science, we would not know about the risk of gynecomastia, and people would likely be using the drug much more casually than they ought to.

Now, when it comes to non-science-based-medicine, you get treatments which are never subjected to science. Thus, if it causes problems to, say, dose children with several times the recommended dose of Lupron even in the absence of any indication of precocious puberty, and continue the drug into adulthood….well, we’ll never know, will we? Nobody’s tracking it for that, and although it is an approved drug and therefore has been studied clinically, it has been studied only for other indications — and since it is not approved for treating autism, using it for that indication is certainly not going to be tracked, and often involves a bit of subterfuge to get insurers to pay for it, which will muddy the evidence (such as it is) even more.

Risperdal is not a sign that evidence-based medicine is worthless. It is a sign that you need evidence-based medicine so you can tell what the pros and cons of various treatments are. Without it, you’re basically just crossing your fingers and hoping.

I don’t see statements like “paucity of evidence,” and so on, to be in support of administering risperidone to autistics.

Nobody disagrees that there are real worries about the use of risperidone in autism. Certainly the potential side effects and the absence of long-term data on safety and efficacy are major concerns. On the other hand, it has perhaps the strongest evidence of efficacy of any medication, and some autistic patients have very severe behavioral issues, so the negatives of risperidone may have to be weighed against treatment alternatives that are also unpalatable. I thought that Jesner et al. accurately laid out the positives and negatives based upon the evidence. They did not, however, recommend that it not be used.

Jesner et al. (2007) concluded not that there was strong evidence, but that there was a “paucity of evidence.” For what Jesner et al. (2007) in fact recommended for practice, see my 1:22 AM comment, above. Re “treatment alternatives” and addressing “behavioral issues” see Tyrer et al. (2008).

It’s interesting to read Dr. Hyman’s interpreation of his health issues, and what he credits his recovery to. Here is a guy who undergoes years of extreme stress in his life – rural family medicine, ER physician, divorce, fight for child custody, being run out of town due to rumors – and blames “chronic fatigue syndrome” and “mercury poisoning” as the cause of his ill health.
A little insight-challenged, perhaps?

Jesner et al. (2007) concluded not that there was strong evidence, but that there was a “paucity of evidence.” For what Jesner et al. (2007) in fact recommended for practice, see my 1:22 AM comment, above. Re “treatment alternatives” and addressing “behavioral issues” see Tyrer et al. (2008).

I said that the evidence was strongest for risperidone, as compared to all other medications. If you disagree with this, please cite the passage in Jesner et al in which they state that there is stronger evidence for any other medication. Jesner et al. concluded that the evidence supported the statement, “Risperidone can be beneficial in some features of autism.” They did note the lack of long-term follow-up, and that further studies were necessary to substantiate its value in actual practice. This is true for all medications that are used for treatment of autism. They did not recommend against its use.

Tyrer et al.’s study was not designed to address treatment of autism. While they did not actively exclude autistic patients from their study group, only 14 out of 86 patients exhibited any symptoms of autism, so even if risperidone were as effective on those patients, as it has found to be in studies that focused specifically on autistic patients, the effect would likely be swamped by the larger number of nonautistic patients.

trrll’s position is that the reported results and stated conclusions of Jesner et al. (2007) are irrelevant and should be disregarded. I disagree.

I also disagree with trrll’s assumption that some medication or other *must* be an effective approach. Based on this unfounded assumption, trrll is certain that a medication with a “paucity of evidence” for its effectiveness, coupled with evidence for major adverse effects, *must* be recommended–regardless that this is not at all what Jesner et al. (2007) conclude. Again, I disagree.

I also disagree that the findings of Tyrer et al. (2008) are irrelevant.

I’m glad to hear things have changed for autistic behavioral therapy. My brother worked as an assistant for a family with an autistic child (essentially a glorified babysitter in his third year of a psych degree), and I heard all sorts of stories about wrapping the 7-yr old up tightly and bottle-feeding him to “regress” him to an infantile stage.

From what I heard, the best way to interact with Zack was to speak softly, move slowly, and offer small food rewards for compliance. And it was the undergraduate assistants who figured it out, not the therapist.

Age of diagnosis is coming down. Seven year olds who were bright enough and motivated enough to learn how to conform could be pretending to be normal in a school setting as a survival mechanism. I suggest that these would be kids whose early presentation would have been too subtle to trigger a diagnosis even 10 years ago. That is why they show up in epidemiological studies with rigorous case finding procedures but were not get picked up by routine health or education screening procedures.

There is also the case of children who do learn how to get by with rule based behaviour until puberty tears up the rule book and they become autistic again.

The other side of this is that improved awareness and understanding may be leading to “too many, too soon” diagnoses that are really specific language or learning difficulties which respond to special education interventions and abate by age 7.

This is all hypothesis and no data. Sorry. We need more longitudinal studies.

trrll’s position is that the reported results and stated conclusions of Jesner et al. (2007) are irrelevant and should be disregarded.

So by quoting Jesner et al.’s actual stated conclusions, as opposed to your mischaracterization of them, I am taking the position that those conclusions are irrelevant and should be discarded? With that degree of reading comprehension, it’s easy to understand how you misread Jesner.

I also disagree with trrll’s assumption that some medication or other *must* be an effective approach.

Reading comprehension problem again. Please cite the passage in which I made any such claim. Note that the conclusion that “risperidone can be beneficial in some features of autism” is Jesner et al.’s, not mine (hence the quote marks).

trrll is certain that a medication with a “paucity of evidence” for its effectiveness, coupled with evidence for major adverse effects, *must* be recommended

Reading comprehension deficiency again. Please reread what I wrote. You will discover that there is no point at which I said than a medication (or, indeed, any therapy) *must* be recommended.

I also disagree that the findings of Tyrer et al. (2008) are irrelevant.

Without, I notice, any response to the factual point that the percentage of participants with any autistic symptoms was so small that it is hard to see how the study could be sensitive enough to pick up a therapeutic effect in autistic patients.

“It’s also quite clear that Hyman is pulling the old “science was wrong before” gambit.”

Blaming autism on the parents is science? Those two blogs you cite define “science” as being based on a little something called “evidence.”

What evidence did the medical establishment on autism and its leader Bruno Bettelheim, a complete crank who was later found to have forged his own credentials and was not even a real psychologist, use to liken the mothers of autistic children to Nazi SS guards?

What evidence did the medical establishment on autism and its leader Bruno Bettelheim, a complete crank who was later found to have forged his own credentials and was not even a real psychologist, use to liken the mothers of autistic children to Nazi SS guards?

So if that was not evidence based science, what relevance does it have to the conclusions of modern scientists and who do base their judgments on evidence? What argument are you trying to make? “Somebody who wasn’t a scientist was wrong before, so therefore I’m right today”?

For what Jesner et al. (2007) concluded, see #72 above, where I quote from the “Authors’ Conclusions” under “Implications for practice.” This can be verified by reading the paper.

According to what trrll has written, trrll’s position is that (1) my statement that Jesner et al. (2007) do not suppport/recommend the use of risperidone is totally unfounded (possibly, I have made it up, including the quotes from the authors’ conclusions with respect to practice); (2) unless Jesner et al. (2007) or I claim another medication is effective, this must mean that risperidone is effective and this must mean that there is sufficient evidence to support its use; (3) Tyrer et al. (2008) should be disregarded–there is nothing relevant in this paper.

I disagree with all these positions (and no, I didn’t and make them up–see above for trrll’s repeated statements). I generally disagree that any treatment for any population should be considered effective when there is a “paucity of evidence” for its effectiveness coupled with evidence for major adverse effects. I generally disagree that a more recent multi-site RCT involving a variety of developmentally disabled people (including autistics), and reporting rapid, dramatic and sustained results, is currently entirely irrelevant and should be disregarded.

I generally disagree that any treatment for any population should be considered effective when there is a “paucity of evidence” for its effectiveness coupled with evidence for major adverse effects.

How odd. You quote “paucity of evidence” but you don’t quote what that refers to. In my experience, the use of quoted sentence fragments in this way is almost always a strong clue that somebody is trying to distort meaning. I wonder if Jesner et al. actually said that there is a paucity of evidence for its effectiveness. Let’s look, shall we:

Although this review reports encouraging improvement in some behavioural aspects of autism spectrum disorder, carers and clinicians should be aware of the paucity of evidence in administering this drug in such a vulnerable group of people. This patient group will inevitably continue to present challenging behaviours over many years; therefore, it is vital to consider issues surrounding long-term use. As the RCTs are of short duration it is impossible to evaluate the long term side effects and efficacy of risperidone, and this is particularly important

So we see that Jesner et al. are actually making it clear that the evidence for therapeutic effects and acceptable levels of adverse effects is from relatively short-duration studies, and that long-term follow-up will be necessary to evaluate whether the benefits and safety are sustained over the long term. This is quite true–in fact, it is true for every medication that is used in treatment of autism.

The term “major adverse effects” does not appear. Here is what Jesner et al. actually say

As well as these limitations, there was evidence of a variety of adverse effects, the most common and significant of which was weight gain. This was marked in children aged 5 – 17 (weight gain for adults was not reported).

Nowhere in the review is their a recommendation that risperidone should not be used.

According to what trrll has written, trrll’s position is that (1) my statement that Jesner et al. (2007) do not suppport/recommend the use of risperidone is totally unfounded (possibly, I have made it up, including the quotes from the authors’ conclusions with respect to practice); (2) unless Jesner et al. (2007) or I claim another medication is effective, this must mean that risperidone is effective and this must mean that there is sufficient evidence to support its use

Reading comprehension problem again. Please cite the words in which I have made the argument that “unless Jesner et al. (2007) or I claim another medication is effective, this must mean that risperidone is effective and this must mean that there is sufficient evidence to support its use”

I disagree with all these positions (and no, I didn’t and make them up–see above for trrll’s repeated statements).

And yet, despite multiple challenges, you can’t seem to quote any words of mine in which I take the positions that you attribute to me.

I generally disagree that a more recent multi-site RCT involving a variety of developmentally disabled people (including autistics), and reporting rapid, dramatic and sustained results, is currently entirely irrelevant and should be disregarded.

Repeating an unsupported assertion does not make it any more valid. Once again, you fail to address the specific issue: that a study in which only 14 out of 86 participants exhibits any symptoms (let alone diagnosis) of autism lacks the sensitivity to judge the benefits and risk of the drug in the autistic population.

I notice that while you persist in attributing positions to me that you cannot substantiate with my words (seems to be a habit; you do it also with Jesner et al.), you haven’t even bothered to ask me what my opinion on the subject actually is.

For what its worth, I don’t think the long-term safety and benefits of any pharmacotherapy used in autism (or any other childhood behavioral condition, for that matter) is adequately established (and most autistic patients receive some form of pharmacotherapy). I agree with Jesner et al. that more studies, with long-term follow-up, are needed to make this judgement. While the adverse effects of risperidone in these short-term studies have not been particularly severe, that may not hold in the long term.

On the other hand, parents and therapists are often dealing with very severe behavioral problems with autistic patients. They are making very hard choices with often inadequate scientific knowledge. They do not know whether the medications are safe in the long-term, but they do know that the long-term prospects for their child/patient are likely to be very poor if these behavioral problems cannot be addressed. I am concerned about the long-term consequences of chronic therapy with a drug like risperidone, but I am hesitant to second-guess the choices of parents and therapists who are on the front line. And I don’t think that mischaracterizing the admittedly limited clinical data does anybody any good.

I disagree that in concluding that there is a “paucity of evidence” with respect to “administering” risperidone to autistics, Jesner et al. (2007) are not in any way referring to what they found with respect to the effectiveness of risperidone. Also, I again disagree that this strongly-worded conclusion is in support of using risperidone with autistics.

To point out the obvious (to me, at least), those interested in what I’m responding to can refer to trrll’s actual comments, above. I responded to what trrll wrote (often, more than once), which may or may not be what trrll meant.

I again disagree that Tyrer et al. (2008) is totally irrelevant and should be disregarded with respect to any population meeting the inclusion criteria. Yes, I’m repeating myself. Also, in my view, the bar should not be lowered when it comes to autistics. This does not result in better outcomes for us, any more than it would for any other population.

“To point out the obvious (to me, at least), those interested in what I’m responding to can refer to trrll’s actual comments, above. I responded to what trrll wrote (often, more than once), which may or may not be what trrll meant.”

So why won’t you quote the relevant parts? It would make it much easier to understand and lend you credibility. Honestly, the only reasons I can think of for not doing so (even after repeated requests) are either a) that trrll didn’t really make the claims she said she did or b) you’re lazy.

Michelle, I’ve taken the liberty to gather what I think are relevant quotes from trrll before you started trying to summarize what you thought she was saying:

ârisperidone can often alleviate some of the more disruptive symptoms of autism that can be an obstacle to educational and behavioral therapies, it also can produce some significant side effects, including hormonal effects, such that its benefits must be weighed against its risks on an individual basis.â

âJesner et al. did not come out definitively for or against risperidone. They state, “Some evidence of the benefits of risperidone in irritability, repetition and social withdrawal were apparent. These must however be considered against the adverse effects, the most prominent being weight gain.” They conclude that “Risperidone can be beneficial in some features of autism,” but that “Further research is necessary to determine the efficacy pf risperidone in clinical practice.”â

âNobody disagrees that there are real worries about the use of risperidone in autism. Certainly the potential side effects and the absence of long-term data on safety and efficacy are major concerns. On the other hand, it has perhaps the strongest evidence of efficacy of any medication, and some autistic patients have very severe behavioral issues, so the negatives of risperidone may have to be weighed against treatment alternatives that are also unpalatable. I thought that Jesner et al. accurately laid out the positives and negatives based upon the evidence. They did not, however, recommend that it not be used.â
âI said that the evidence was strongest for risperidone, as compared to all other medications. If you disagree with this, please cite the passage in Jesner et al in which they state that there is stronger evidence for any other medication. Jesner et al. concluded that the evidence supported the statement, “Risperidone can be beneficial in some features of autism.” They did note the lack of long-term follow-up, and that further studies were necessary to substantiate its value in actual practice. This is true for all medications that are used for treatment of autism. They did not recommend against its use.
Tyrer et al.’s study was not designed to address treatment of autism. While they did not actively exclude autistic patients from their study group, only 14 out of 86 patients exhibited any symptoms of autism, so even if risperidone were as effective on those patients, as it has found to be in studies that focused specifically on autistic patients, the effect would likely be swamped by the larger number of nonautistic patients.â

And then you conclude âtrrll’s position is that the reported results and stated conclusions of Jesner et al. (2007) are irrelevant and should be disregarded. I disagree.
I also disagree with trrll’s assumption that some medication or other *must* be an effective approach. Based on this unfounded assumption, trrll is certain that a medication with a “paucity of evidence” for its effectiveness, coupled with evidence for major adverse effects, *must* be recommended–regardless that this is not at all what Jesner et al. (2007) conclude. Again, I disagree.

And I honestly don’t see how you got that from what she wrote. If I somehow missed an important quote, please (PLEASE!) quote it for us now, so we can see what you’re disagreeing with (which, ya know, would’ve been really helpful the first time it was asked for).

In my view, everything trrll wrote is “relevant” (others apparently disagree). I see no point in repeating everything trrll wrote every time I respond to what trrll wrote.

trrll’s position is that, contrary to what I wrote, there is sufficient evidence to support the adminstration of risperidone to autistics. This is not what Jesner et al. (2007) found or concluded, if you read the study’s results and conclusions re practice.

trrll also demands that Jesner et al. (2007) and I claim that another medication is effective. If we fail to do so, then according to trrll, there must be sufficient evidence supporting the administration of risperidone to autistics. I’ve pointed out the false assumption underlying this view (which again is contrary to the conclusions of Jesner et al., 2007, re practice), and have disagreed with it.

Good article. But what has Dr. Hymanâs nonsense âÂ some of it apparent even to a non-surgeon like myself âÂ have to do with appearing on –âwhere else?â–The Huffington Post. I find much of interest on HuffPost, some very well-written articles and news tidbits Iâd be unlikely to find elsewhere. I also found among the responses to this and later articles of Dr Hyman âÂ whose inclusion on HuffPost IS unfortunate â a number challenging his science and his motives, my own among them.

Oh, well; Arianna can take care of herself well enough. I still appreciate the extra ammo you provide for my own blog comments, at those moments when I canât seem to resist. Not unlike this one.

I can’t believe the number of closed-minded commenters are lurking out there. More and more scientific evidence is pointing to affects of pesticides, hormones & other poisons from our environments on our overall health. Not to mention the lack of vitamins in our fast-food, non-organic diets.
My son is on the spectrum and has shown HUGE improvements just by placing him in a dairy-free diet and a vitamin regimen. Changes I made before I ever heard of this Mark Hyman person. Changes that I just consider to be common sense. When I briefly re-introduced dairy last year, his teacher noticed a remarkable difference in his behaviour (hyperactivity and aggression) and ability to focus (he became unable to make eye-contact after months of clear focus & communication and CLEAR eye-contact) and asked me to take him back off the dairy. And I haven’t even tried making him go gluten-free yet, but after watching “The Ultramind Solution” I am now considering making this change too. I believe that I can feed my son with healthy fruits, vegetables, chicken, beef & fish, rice & corn without the need for bread & flour products.
I honestly feel sorry for the many commenters here whose children will probably suffer for many more years to come because they are too stubborn to give their child vitamins and are too lazy to try alternative diets. What is the harm in TRYING to eliminate dairy and gluten for 6 weeks?
My son is doing fantastic and even my health & overall energy has improved because I take the same vitamins that he does (in higher doses) and am following the same food-restrictions (at this point, only dairy, but hoping to slowly change that).

More and more scientific evidence is pointing to affects of pesticides, hormones & other poisons from our environments on our overall health. Not to mention the lack of vitamins in our fast-food, non-organic diets.

Funny how you managed to not provide any “scientific” evidence (which I suspect you think are links to certain websites, and not real peer reviewed papers).

I’m with you Suzanne – keep on trying! Having a lackluster life (like many of the posters here) before being diagnosed with gluten intolerance, getting off gluten, and getting a life, I’d have thunk the way they do, too. I was stupid on that stuff. I have a kid on the AS, too. She’s stupid and won’t change, either (I found out too late to change her diet for her). Fix the mother’s gut (most mom’s are fat and/or malnourished thin and/or yeasty), you fix the baby/brain. Duh. If people did their homework, tried something new, rather than preferring to listen to themselves spew idiocy, our society might actually progress. Please don’t correct my grammar, I did what I could while in school while eating gluten/casein.

@Rogue: I don’t know what a Poe is, but likely, not.
@Kristin: My relationship with my kid is great, thanks. Were it not for my tenacity and perseverance she would be worse off, I promise. What I write is from PURE unadulterated FRUSTRATION (not something that I share with her for gawd’s sake) at the close-mindedness and laziness of people who won’t try. I write this because I’m anonymous and I’m venting. I’m watching people around me die from food-related illnesses which can be prevented. We pay higher taxes to support this sickness? And to have people here close down hope for others because it didn’t work for their own kid? Well, it’s working for me. I thought it should be out there for others to know.

BTW, DAN doctors’ protocol are more intense than Dr. Hyman’s. How’s HE gonna pay for a “respectable” trial? You think vitamin/supplement companies have the money that Pharma does?

I would never say my autistic son is stupid, anonymous or not. I am not going to argue with you, you have come across here as mean and uneducated. I am not saying that is what you are, just how seem to be, judging from your comment.

. I’m watching people around me die from food-related illnesses which can be prevented.

Wait, what? Where is the public health department so bad that people around you are dying of botulism, amoebic dysentery, salmonella, E-coli, cholera, hepatitis, typhoid, rotavirus, tuberculosis, brucellosis and other food related illnesses?

My brother was in India working at the American Embassy for over a year. The house he lived in was in a nice part of New Dehli, yet because water was only available for limited time each day each house had a pump to pull water to fill a roof tank. Unfortunately the pumps caused enough pressure to pull from the sewer system, which contaminated that water. So each house had a water distiller to create potable water.

Good grief, if you pay high taxes and your public health department fails on basic water treatment and restaurant/supermarket inspection, you have really big problems!

Emma & Suzanne … Good going for being wise. Unfortunately there are people who are so scientific they can’t live without double blind studies to prove anything and everything. Remember, many thought the world was flat and couldn’t even begin to comprehend the world was in fact round! These peeps will complain and spew over and over again, until a double blind study proves other. The way they flow!

Emma & Suzanne … Good going for being wise. Unfortunately there are people who are so scientific they can’t live without double blind studies to prove anything and everything. Remember, many thought the world was flat and couldn’t even begin to comprehend the world was in fact round! These peeps will complain and spew over and over again, until a double blind study proves other. The way they flow!

Remember, many thought the world was flat and couldn’t even begin to comprehend the world was in fact round!

Not even wrong: Eratosthenes measured the Earth’s circumference over 2100 years ago. The spherical nature of this planet has been known by educated folks even longer.

Obviously you speak from rumor and hyperbole. Do try to do better next time. Especially since doing an vaccinated versus unvaccinated “double blind study” has been discussed on this blog as being very unethical several times.

I really have no doubt that one of these days we’ll get a visit from an anti-vaxxer so fanatical about seeing their viewpoint prevail over logic that they will, at the same time, condemn all us “scientific” types for only accepting double-blind studies (rather than also accepting their anecdotal data) and insist that our evidence of their vaccines-cause-autism theories being wrong are meaningless because it doesn’t come from a vacc-versus-completely-unvacc double-blind RCT.

DAN doctors’ protocol are more intense than Dr. Hyman’s. How’s HE gonna pay for a “respectable” trial? You think vitamin/supplement companies have the money that Pharma does?

Bearing in mind that just in the United States, $33.9 bn was spent on altenative therapies in 2007, yes, I do think that they do have the money to spend on scientific, double blind trials. Just more special pleading from the AltMed shill.
Who do you think manufactures all those vitamins and suppliments (hint, not a little granny in her kitchen)?

This is the strangest blog I’ve ever seen! I don’t think that eating whole organic foods and having your diet in balance is scarey or awful. And I certainly think that common sense tells us that our children’s diet have a great effect on how they act and feel. As a teacher of 40 years, I think that Dr. Hyman’s theories generally are right and I don’t get what motivates anyone to pour such vehement statements about him on here. I abhor the ease which the internet provides for someone to pick apart anyone and everyone. There is NO ONE who has reached perfection.

It’s possible that Dr. Hyman doesn’t know that his recommendations are ill founded. Some of what he says is reasonable; however, many of his conclusions, and the so-called scientific basis he claims, are wrong. The danger is that he is misleading the public — and he may not even know it, himself.

We in the general public are woefully unskilled in scientific analysis. We treat science as if it’s a great and unlearnable mystery. And we are easily misled by people who wave apparent credentials.

Dr. Hyman’s CV shows he’s received standard medical training. Unfortunately, such training may not adequately address the interpretation of statistics, a serious vulnerability which may leave the physician with unwarranted confidence in his/her ability to interpret the results and implications of scientific research.

Physicians who wish to perform scientific research generally obtain the PhD as well. Dr. Hyman does not have a PhD. Yet he asserts — persuasively, and with great personal confidence — conclusions which are unwarranted by the evidence.

Statistician Gerd Gigerenzer specifically discusses some statistical errors physicians typically make in his book Calculated Risks: How to Know When Numbers Deceive You.

From another reader’s review:
“Astonishingly, doctors and lawyers don’t understand risk any better than anyone else. Gigerenzer reports a study in which doctors were told the results of breast cancer screenings and then were asked to explain the risks of contracting breast cancer to a woman who received a positive result from a screening. The actual risk was small because the test gives many false positives. But nearly every physician in the study overstated the risk. Yet many people will have to make important health decisions based on such information and the interpretation of that information by their doctors.”

Patricia, you have it backwards. Hyman has to show his treatment is effective. You do not get to come up with something without evidence, claim it works, and then demand people demonstrate you are wrong. Orac and others on this thread have also given very good reasons why what he presents here is not correct.

Louise, I get from your comment that you have never attended an IEP meeting for a child with disabilities. If you do actually have an autistic child, I suggest you look closely at the options presented to you, and look more critically at the people who are being very “nice” to you now. Because (and trust me on this), it will come and bite you in the posterior later.

Anyone with a modicum of scientific knowledge, healthy skepticism, and open-minded curiosity will probably concede that the modern mainstream medical system, both in the realm of research and development and in the realm of practical treatment, is deeply flawed. To begin with, corporate interests exert an inappropriate influence on conventional medical opinion, which is at best incomplete and at worst inaccurate or misguided–note my use of the word “opinion,” which is the only suitable term for the vast majority of “accepted” medical consensus. At present, the functional intricacies of the human system are so poorly understood, and the existing empirical knowledge so fragmentary, that even the most pre-eminent scientists in the world are limited, essentially, to a series of educated conjectures that only partially or incompletely encompass the truth. Furthermore, the exclusive emphasis on synthetic chemicals in the treatment of the entire spectrum of human disease, and the denial of the influence of environmental factors, contradicts some of the most fundamental principles of human biology. The human body is an extraordinarily complex organic system composed of an innumerable quantity of inter-related elements, none of which can be decisively isolated from the whole, nor from the larger environmental systems of which the individual system is merely a part. The recognition of the interrelatedness of all physiological phenomena lies at the heart of “systems” biology–and “functional” medicine merely seeks to extend this awareness of interconnectedness to the interactions between the human body and its environment. My perception is that people like Mark Hyman are merely pursuing a deeper and more nuanced understanding of the way that physiological systems function on the molecular level, and using this (developing) understanding to identify the many possible reasons that healthy physiology can malfunction. Conventional medicine is so inordinately preoccupied with the synthesis, evaluation, and deployment of drugs that it hardly bothers to ask why the body is malfunctioning in the first place. At best, its vague allusions to the role of heredity are no more well-substantiated than any of Hyman’s claims.
To note that many profoundly important discoveries and scientific advances throughout history have been met with vehement opposition does not prove the legitimacy of Hyman’s approach; but it does offer a compelling reason to remain open-minded and skeptical of all “established” knowledge. Let us not forget that bloodletting was a standard medical practice for many centuries, and anyone that questioned the legitimacy of this approach or suggested more sensible alternatives would have been vilified, ostracized, or disregarded. This, again, does not prove the particular validity of Hyman’s ideas, but it serves as a reminder that the common or “mainstream” medical opinion at any given time is by no means unequivocally accurate.
I cannot understand why alternative medicine is so venomously attacked by proponents of the mainstream medical community. Alternative approaches have helped countless suffering people for whom conventional medicine was ineffective or damaging. For example, I have struggled with mental health issues for years, and I’ve consistently found conventional medicine to be either useless or actively destructive to both my emotional and physical well-being. The help and advice that I’ve received from “alternative” practitioners has practically saved my life on a number of occasions.
Please, try to be open-minded and tolerant of all medical hypotheses, particularly those whose motivation is to alleviate human suffering, not to maximize corporate profits. Certainly some caution and skepticism is warranted when considering alternative approaches, and undoubtedly some genuine “quackery” exists; but to dismiss intelligent, thoughtful, sensible, and well-intentioned arguments simply because they contradict the tenuously-supported mainstream “consensus” is gravely irresponsible and injurious to the pursuit of scientific truth.
Thank you to all those who have offered thoughtful and considerate input.

Anyone with a modicum of scientific knowledge, healthy skepticism, and open-minded curiosity will probably concede that the modern mainstream medical system, both in the realm of research and development and in the realm of practical treatment, is deeply flawed. To begin with, corporate interests exert an inappropriate influence on conventional medical opinion, which is at best incomplete and at worst inaccurate or misguided–note my use of the word “opinion,” which is the only suitable term for the vast majority of “accepted” medical consensus. At present, the functional intricacies of the human system are so poorly understood, and the existing empirical knowledge so fragmentary, that even the most pre-eminent scientists in the world are limited, essentially, to a series of educated conjectures that only partially or incompletely encompass the truth. Furthermore, the exclusive emphasis on synthetic chemicals in the treatment of the entire spectrum of human disease, and the denial of the influence of environmental factors, contradicts some of the most fundamental principles of human biology. The human body is an extraordinarily complex organic system composed of an innumerable quantity of inter-related elements, none of which can be decisively isolated from the whole, nor from the larger environmental systems of which the individual system is merely a part. The recognition of the interrelatedness of all physiological phenomena lies at the heart of “systems” biology–and “functional” medicine merely seeks to extend this awareness of interconnectedness to the interactions between the human body and its environment. My perception is that people like Mark Hyman are merely pursuing a deeper and more nuanced understanding of the way that physiological systems function on the molecular level, and using this (developing) understanding to identify the many possible reasons that healthy physiology can malfunction. Conventional medicine is so inordinately preoccupied with the synthesis, evaluation, and deployment of drugs that it hardly bothers to ask why the body is malfunctioning in the first place. At best, its vague allusions to the role of heredity are no more well-substantiated than any of Hyman’s claims.
To note that many profoundly important discoveries and scientific advances throughout history have been met with vehement opposition does not prove the legitimacy of Hyman’s approach; but it does offer a compelling reason to remain open-minded and skeptical of all “established” knowledge. Let us not forget that bloodletting was a standard medical practice for many centuries, and anyone that questioned the legitimacy of this approach or suggested more sensible alternatives would have been vilified, ostracized, or disregarded. This, again, does not prove the particular validity of Hyman’s ideas, but it serves as a reminder that the common or “mainstream” medical opinion at any given time is by no means unequivocally accurate.
I cannot understand why alternative medicine is so venomously attacked by proponents of the mainstream medical community. Alternative approaches have helped countless suffering people for whom conventional medicine was ineffective or damaging. For example, I have struggled with mental health issues for years, and I’ve consistently found conventional medicine to be either useless or actively destructive to both my emotional and physical well-being. The help and advice that I’ve received from “alternative” practitioners has practically saved my life on a number of occasions.
Please, try to be open-minded and tolerant of all medical hypotheses, particularly those whose motivation is to alleviate human suffering, not to maximize corporate profits. Certainly some caution and skepticism is warranted when considering alternative approaches, and undoubtedly some genuine “quackery” exists; but to dismiss intelligent, thoughtful, sensible, and well-intentioned arguments simply because they contradict the tenuously-supported mainstream “consensus” is gravely irresponsible and injurious to the pursuit of scientific truth.
Thank you to all those who have offered thoughtful and considerate input.

Anyone with a modicum of scientific knowledge, healthy skepticism, and open-minded curiosity will probably concede that the modern mainstream medical system, both in the realm of research and development and in the realm of practical treatment, is deeply flawed. To begin with, corporate interests exert an inappropriate influence on conventional medical opinion, which is at best incomplete and at worst inaccurate or misguided–note my use of the word “opinion,” which is the only suitable term for the vast majority of “accepted” medical consensus. At present, the functional intricacies of the human system are so poorly understood, and the existing empirical knowledge so fragmentary, that even the most pre-eminent scientists in the world are limited, essentially, to a series of educated conjectures that only partially or incompletely encompass the truth. Furthermore, the exclusive emphasis on synthetic chemicals in the treatment of the entire spectrum of human disease, and the denial of the influence of environmental factors, contradicts some of the most fundamental principles of human biology. The human body is an extraordinarily complex organic system composed of an innumerable quantity of inter-related elements, none of which can be decisively isolated from the whole, nor from the larger environmental systems of which the individual system is merely a part. The recognition of the interrelatedness of all physiological phenomena lies at the heart of “systems” biology–and “functional” medicine merely seeks to extend this awareness of interconnectedness to the interactions between the human body and its environment. My perception is that people like Mark Hyman are merely pursuing a deeper and more nuanced understanding of the way that physiological systems function on the molecular level, and using this (developing) understanding to identify the many possible reasons that healthy physiology can malfunction. Conventional medicine is so inordinately preoccupied with the synthesis, evaluation, and deployment of drugs that it hardly bothers to ask why the body is malfunctioning in the first place. At best, its vague allusions to the role of heredity are no more well-substantiated than any of Hyman’s claims.
To note that many profoundly important discoveries and scientific advances throughout history have been met with vehement opposition does not prove the legitimacy of Hyman’s approach; but it does offer a compelling reason to remain open-minded and skeptical of all “established” knowledge. Let us not forget that bloodletting was a standard medical practice for many centuries, and anyone that questioned the legitimacy of this approach or suggested more sensible alternatives would have been vilified, ostracized, or disregarded. This, again, does not prove the particular validity of Hyman’s ideas, but it serves as a reminder that the common or “mainstream” medical opinion at any given time is by no means unequivocally accurate.
I cannot understand why alternative medicine is so venomously attacked by proponents of the mainstream medical community. Alternative approaches have helped countless suffering people for whom conventional medicine was ineffective or damaging. For example, I have struggled with mental health issues for years, and I’ve consistently found conventional medicine to be either useless or actively destructive to both my emotional and physical well-being. The help and advice that I’ve received from “alternative” practitioners has practically saved my life on a number of occasions.
Please, try to be open-minded and tolerant of all medical hypotheses, particularly those whose motivation is to alleviate human suffering, not to maximize corporate profits. Certainly some caution and skepticism is warranted when considering alternative approaches, and undoubtedly some genuine “quackery” exists; but to dismiss intelligent, thoughtful, sensible, and well-intentioned arguments simply because they contradict the tenuously-supported mainstream “consensus” is gravely irresponsible and injurious to the pursuit of scientific truth.
Thank you to all those who have offered thoughtful and considerate input.

Anyone with a modicum of scientific knowledge, healthy skepticism, and open-minded curiosity will probably concede that the modern mainstream medical system, both in the realm of research and development and in the realm of practical treatment, is deeply flawed.

“Deeply” is subjective, but certainly there are issues. Orac discusses them regularly.

To begin with, corporate interests exert an inappropriate influence on conventional medical opinion, which is at best incomplete and at worst inaccurate or misguided–note my use of the word “opinion,” which is the only suitable term for the vast majority of “accepted” medical consensus. At present, the functional intricacies of the human system are so poorly understood, and the existing empirical knowledge so fragmentary, that even the most pre-eminent scientists in the world are limited, essentially, to a series of educated conjectures that only partially or incompletely encompass the truth.

Imperfect knowledge is not the same thing as no knowledge. We know quite a lot about how the human body works.

Furthermore, the exclusive emphasis on synthetic chemicals in the treatment of the entire spectrum of human disease, and the denial of the influence of environmental factors, contradicts some of the most fundamental principles of human biology.

Good thing said “exclusive emphasis” exists only as a straw man promulgated by sCAM artists.

My perception is that people like Mark Hyman are merely pursuing a deeper and more nuanced understanding of the way that physiological systems function on the molecular level, and using this (developing) understanding to identify the many possible reasons that healthy physiology can malfunction.

Your perception is inaccurate. It’s the actual scientists who are involved in such endeavors; Hyman and his ilk try to cram all facts into his preconceived, and mostly counterfactual, notions which have nothing to do with reality.

Conventional medicine is so inordinately preoccupied with the synthesis, evaluation, and deployment of drugs that it hardly bothers to ask why the body is malfunctioning in the first place.

BS. The search for root causes, and the use of non-pharmaceutical methods wherever applicable (esp. diet, exercise, and other lifestyle factors) is CORE to conventional medicine. (Seriously, who HASN’T had their GP lecture them repeatedly on eating right and getting more exercise?)

It’s instructive to contrast this with the attitudes of Hyman and other sCAMmers. In that world, root causes are entirely ignored. Even symptoms are largely irrelevant. Everybody gets exactly the same treatments (which quite often involve many times more pills than any MD in history has ever prescribed to a single patient).

To note that many profoundly important discoveries and scientific advances throughout history have been met with vehement opposition does not prove the legitimacy of Hyman’s approach; but it does offer a compelling reason to remain open-minded and skeptical of all “established” knowledge.

To invoke the Galileo gambit, one must not only have one’s ideas rejected. One must also be RIGHT.

Let us not forget that bloodletting was a standard medical practice for many centuries, and anyone that questioned the legitimacy of this approach or suggested more sensible alternatives would have been vilified, ostracized, or disregarded. This, again, does not prove the particular validity of Hyman’s ideas, but it serves as a reminder that the common or “mainstream” medical opinion at any given time is by no means unequivocally accurate.

Actually, it’s a beautiful illustration of what’s WRONG with Hyman’s ideas. SCIENCE was what showed bloodletting to be inaccurate. The emphasis on anecdote and personal experience deployed in support of Hyman’s ideas is exactly how bloodletting was justified.

I cannot understand why alternative medicine is so venomously attacked by proponents of the mainstream medical community.

Because it’s fraudulent and hurts people?

Alternative approaches have helped countless suffering people for whom conventional medicine was ineffective or damaging.

Actually, it’s never been demonstrated to do so. You see, anything that IS demonstrated to work promptly becomes part of “conventional” medicine.

For example, I have struggled with mental health issues for years, and I’ve consistently found conventional medicine to be either useless or actively destructive to both my emotional and physical well-being. The help and advice that I’ve received from “alternative” practitioners has practically saved my life on a number of occasions.

N=1 provides no information; placebo effect, regression to the mean, etc. mean that you have no idea what effect either set of treatment actually had.

Please, try to be open-minded and tolerant of all medical hypotheses, particularly those whose motivation is to alleviate human suffering, not to maximize corporate profits.

Open-mindedness is one thing, but in order to place any credence in sCAM you have to be so open-minded that your brains fall out. Noting that a claim has been resoundingly demonstrated to be false is not closed-minded. Refusing to accept that it has been refuted, however, IS.

Certainly some caution and skepticism is warranted when considering alternative approaches, and undoubtedly some genuine “quackery” exists; but to dismiss intelligent, thoughtful, sensible, and well-intentioned arguments simply because they contradict the tenuously-supported mainstream “consensus” is gravely irresponsible and injurious to the pursuit of scientific truth.

I’ve never seen a single argument in favor of sCAM which could be fairly characterized as intelligent, thoughtful, OR sensible. Well-intentioned, I’ll grant you. But when arguments are factually false, and repeatedly proven so, NOT rejecting them is not only gravely irresponsible and injurious to the pursuit of scientific truth, but foolish.

Scott,
I appreciate your response to my comment. Allow me to state that I have no personal or even philosophical allegiance to Mark Hyman or any other medical practitioner of any stripe. I am as skeptical of him as I am of anyone else. I’m simply a person who has suffered as a result of standard modern medical practices, and it seems prudent to consider alternative viewpoints before categorically rejecting them, as many proponents of conventional medicine seem to do. Also, I’m a newcomer to the realm of cyber-pugilism (thus the unintentional “wall of text in triplicate”), and I don’t even know how to quote someone else’s comment. But I’ll respectfully attempt to address some of your responses.

–“We know quite a lot about how the human body works”–such an assertion can only be true in purely relative terms. If our knowledge of human physiology were as extensive as you claim, it might be possible to identify why conventional pharmacological treatments create so many unintended complications, as evidenced by the nearly universal occurrence of what are euphemistically labeled “side effects.” In fact, the only medications that I have taken in my lifetime that listed no common side effects were essentially orthomolecular treatments: namely, thyroid hormone and “medical foods” such as methylfolate. If our knowledge of human physiology is so vast, then why haven’t we been able to identify the sources of common pharmacological side effects and correct them? I recognize that this is a dynamic, ongoing process, and I don’t doubt that progressively safer and more effective medications will continue to emerge, but the complications inherent in conventional pharmacological treatment are indicative of one of its fundamental fallacies: no drug can truly correct the organic dysfunction of biological systems whose unfathomable complexity and elegance is the product of millions of years of natural selection. Beyond the monstrous arrogance of the assumption that man-made chemicals are capable of correcting imbalances within these ancient and delicate systems, such a viewpoint is scientifically invalid: synthetic pharmacological agents consist of a configuration of atoms that has no place within the extraordinarily sophisticated economy of human physiology. The human body has no genomic provision for accommodating the abnormal chemical reactions that they produce. The sort of scientific research that I support attempts to identify the molecular mechanisms of the dysfunction, rather than evaluate the effectiveness of a synthetic agent in managing symptoms. The oft-used “smoke and fire” analogy, though an intolerable cliche, is appropriate: treating symptoms with pharmacology is akin to struggling to conceal, dissipate, or otherwise manage the presence of the proverbial “smoke.” But the only sustainable way to eliminate the smoke is to address its cause: the fire. Any protocol that fails to investigate and address the “fire” will ultimately fail, as the fire continues to produce smoke that becomes increasingly difficult to manage. Yes, I agree that an investigation of root causes is not entirely absent from conventional medicine, but it is preposterous to assert that this investigation lies at the “core” of conventional medicine. I speak from personal experience: I have visited upwards of 30 conventional doctors and psychiatrists in three different states during the past four years. On only one occasion have I received practical information regarding diet, exercise, and lifestyle from any of these doctors, even after prolonged and repeated visits. Even when I was admitted to a hospital following severe malnutrition due to an eating disorder, I received no information regarding nutrition, nor was I evaluated for nutritional deficiencies or systemic abnormalities. I was prescribed an SSRI and sent home. Even when a GP admonishes a patient to “eat right and exercise,” such injunctions are little more than vague, simplistic, and cursory repetitions of whatever meager nutritional education the M.D. might have received in medical school. The purpose of functional medicine, of which Mark Hyman is merely one particularly visible proponent, is (at least in part) to define more clearly what it actually means to “eat right,” and to determine what conditions might prevent the healthy functioning of physiological systems even in the presence of adequate nutrition and exercise. Sure, Hyman might be a quack–I don’t care one way or the other. It is the principles of functional medicine, as they diverge from conventional practices, that I find valid, intriguing, and worthy of vocal support.

–You are correct: the emphasis on pharmacology is not “exclusive.” But it is certainly dominant, and unjustifiably so.

–You are also correct that it is the scientists involved in the pursuit of knowledge, not people like Mark Hyman, that are “pursuing a deeper and more nuanced understanding” of human physiology. What I support is the field of functional medicine and the possibilities that it presents, not Mark Hyman or any other individual practitioner. Part of my point, though, is that personally attacking a single popular physician is not a valid grounds for discounting the legitimacy of alternative medicine entirely. The man is not identical with the ideas that he supports and propagates. And it is the ideas that I believe are worthy, at the very least, of sensitive consideration.

–“To invoke the Galileo gambit, one must not only have one’s ideas rejected. One must also be RIGHT.” This is true, but it is arrogant and absurd for you to assume that you possess the authority to determine who is “right” and who is not. Similarly, your dismissal of alternative medicine as “fraudulent” presupposes an intellectual authority that I am certain you do not possess, as no human being in the history of the race has ever possessed such authority. Yes, of course there are SIGNIFICANT problems and issues with alternative medicine. It is as deeply flawed as conventional medicine, and perhaps more so. But this fact does not warrant the categorical dismissal of novel hypotheses that contradict the prevailing medical consensus. I have never encountered a hypothesis “promulgated” by the proponents of functional medicine that was NOT supported by scientific evidence. Granted, the evidence is fragmentary, inconclusive, and difficult to interpret, but such is the nature of all scientific investigations, being merely partial revelations of a truth that is overwhelmingly complex and in a state of perpetual flux. To ignore the discoveries of functional medicine, however inconclusive they may be, is an impediment to the advancement of medicine as a whole.

–There are so many logical fallacies in your response to the “bloodletting” analogy that it is difficult to address them all. First of all, it is irrelevant to point out that scientific advances exposed the inaccuracy of this practice: functional medicine is a branch of scientific inquiry, one devoted in part to determining why conventional medicine is so dysfunctional. It is in this capacity that functional medicine may in fact serve a role analogous to that of the first opponents of bloodletting. Secondly, the process by which most drugs, particularly psychiatric drugs, are approved relies heavily on personal experience and anecdotal evidence: the efficacy of the drug is determined by the change in self-reported symptoms on various surveys in response to treatment. This is, as I’m sure you can recognize, simply a codified and systematized method of evaluating how a drug influences subjective experience. There is, at present, no genuinely objective evidence for the efficacy of psychiatric drugs (for example) in alleviating mental illness: the approval of the drug is based upon subjective experiences that are converted, fallaciously, into objective evidence by a standardized survey. Yes, it is problematic that many practitioners of alternative medicine lack any similarly standardized method of evaluating success; but the lack of such a system does not NECESSARILY invalidate the reported success of their treatments. It simply indicates that they lack the large-scale funding necessary to conduct statistically relevant trials of their methods. And where does that funding come from? Certainly not from independent practitioners of the methods in question. Meanwhile, conventional physicians frequently prescribe medications for “off-label” applications for which there is no evidence whatsoever–except for their own clinical experience with hundreds of different patients, which is no more intrinsically valid than the clinical experience of any practitioner of alternative or functional medicine.

–“In that world, root causes are entirely ignored. Even symptoms are largely irrelevant. Everybody gets exactly the same treatments (which quite often involve many times more pills than any MD in history has ever prescribed to a single patient).” This statement is simply factually inaccurate in several respects. Root causes are the primary focus of functional medicine and symptoms are of primary importance. Certainly it is true that treating illness with nutritional supplements, for example, requires a person to swallow a great number of “pills” every day, but the inconvenience of a given treatment is neither evidence for nor against its efficacy. Swallowing a handful of dietary supplement capsules every day is undoubtedly inconvenient, but it is essentially no more inconvenient than eating, and it MAY (and here I emphasize my uncertainty and skepticism) provide the body with the materials it needs to repair the dysfunction. Of course, it may also create additional problems; I acknowledge that possibility as well. But both the possibility for harm and the possibility for benefit exist in any medical treatment, whether supported or unsupported by clinical evidence. In any case, commenting on the number of pills involved in any treatment is completely irrelevant.

–Finally–you claim that functional or alternative medicine “hurts people.” What evidence do you have to support this claim? If it is anecdotal, then it is no more valid to this discussion than the thousands upon thousands of anecdotal reports of the benefits of such treatment. I need hardly mention that conventional medicine also incapacitates, cripples, maims, kills, or otherwise harms millions of people every year. The evidence of this phenomenon is far more concrete: it takes the form, for example, of the $700 million that Eli Lilly and Co. spent settling eight thousand personal-injury complaints in 2005.

Anyway, I do hope that what I’ve just written qualifies as the first intelligent, thoughtful, and sensible argument–not for “sCAM” per se, but for the necessity of considering alternative viewpoints–that you’ve yet encountered. Any statement that contains the word “never,” by the way, is rarely true. I’d be interested in your response.

Really? I think my post is perfectly legible. The punctuation and grammar are sound and there are no spelling problems. With my limited experience in Internet forums, I have formatted it as well as I am able. If you can read a book, you can read what I’ve just posted. I am genuinely interested in hearing what you have to say. I’m certainly not trying to be adversarial–I would truly enjoy reading your response. Please give it some effort. Otherwise, I hope that other people reading this forum will appreciate some of the things I’ve said.

Aldous, and did you read my second paragraph? Why did you post on a year old article instead on today’s article on Hyman?

Not many are willing to read a wall of text on something over a year old!! You did not even address the subject of autism. Why should we bother with you if you cannot even keep up with the current discussion, which is about Hyman and cancer research?

Chris: I wasn’t aware of the newer article on Hyman. I don’t spend much time on the Internet. I know this article is old, but I’ve just discovered it today, and I felt inclined to comment. Had I been aware of the newer article, I would have commented there. I was more interested in a broader discussion of the relative merits and drawbacks of alternative medicine, which I think is deeply relevant to this topic–the author of this article dismisses Hyman’s work, and by extension functional and alternative medicine as a whole, as a “quacktastic woo-fest,” which I think is a dangerously limited viewpoint. Respectful discussion, not sarcastic verbal sparring, is what I was aiming for.
Well, I’m actually not sure why I decided to comment in the first place. And I don’t feel particularly inclined to condense my sentiments into a series of convenient emoticons that any Web-browser can decipher at a glance. If anyone would like to read what I wrote and respond to it thoughtfully, respectfully, intelligently, etc., I’d enjoy hearing what they have to say. Otherwise I’ll simply take my leave.

But if you’d like to get into a general discussion of CAM, then (a) this is the wrong thread to do it in and (b) you would be well-served to read through some of the archives – you can click on the category names at the top of the post for a listing – in order to reduce redundancy.

wasn’t aware of the newer article on Hyman. I don’t spend much time on the Internet. I know this article is old, but I’ve just discovered it today, and I felt inclined to comment. Had I been aware of the newer article, I would have commented there.

Some basic rules before commenting on a blog or forum:

1) If you find an article through Google, before commenting go to the first page and see what is under discussion.

2) Get to know the place, lurk for a while. Just like Scott mentioned.

3) Become familiar with the writing style, especially in how issues are discussed.

4) Try to proof read your comments (okay, we don’t all do that).

5) If you think you want to bring a subject up to the participants’ attention, please use the search box on the upper left side of this page to see if it has been discussed before.

6) If you get an error when posting a comment, before posting again… open another window to see if it was actually posted.

Great post. I just had Dr. Hyman’s most recent Huffpost garbage forwarded to me (a Neuro grad student) by my parents, who recently (and unbeknownst to me) paid a large amount (especially given their very limited resources) to one of his collaborators to cure my autistic brother. My great anger makes reasoning with them difficult, especially with neither having any scientific background, so it was nice to be able to link to this. It most likely won’t change their mind at all, but I’m nearing my wit’s end. Keep up the good work.

— Aldous:
“The sort of scientific research that I support attempts to identify the molecular mechanisms of the dysfunction, rather than evaluate the effectiveness of a synthetic agent in managing symptoms.”
I can’t agree more. I am on a quest, so to speak, to find why my daughter seems to be dealing with auto-immune diseases. The medications she has been prescribed produce marginal relief from the many symptoms she is plagued with-and then the symptoms return. (Two thyroid hormones for the hypothyroidism and Hashimoto’s, birth control pills and metformin for the PCOS, Miralax for the severe constipation, phentermine, chromium picolinate, potassium and a diuretic for weight issues, oral antibiotics and clindagel for acne, Lidex, Elocon for skin rashes, Flexeril for headaches, wellbutrin xl for depression, augmentin for sore throat, gluten free diet for intolerance–did not have biopsy)Yet she still has acne, she is still overweight, she is still depressed, her thyroid levels have NOT stabilized, she is STILL NOT ovulating and rashes/bumps/blisters still appear. I truly don’t know if we can even afford any more medicines. Some are quickly replaced with others, different dosages, etc. To only be stopped and prescribed something else.

I stumbled upon this site after looking for negative reviews of Dr. Hyman’s practices, as I sometimes do for prescribed medications and doctors she will be seeing. At this point, we are willing to do something as drastic as what he suggests since the meds just are NOT working to alleviate the problems.
She is a full time student majoring in finance/minor in acctg, divorced and living back at home. COBRA has run its course, she has no medical insurance. We are trying to find insurance coverage and will be sure her health remains the priority – she has seen five specialists within the last year – mostly referrals by other specialists.
At best, we are told “possibly genetic”. There may have been a “trigger” virus – EpsteinBarre? Mono? She has the antibody to EBV EBNA and EBV VCA. Her doctor had her tested due to her extreme fatigue, but since it was considered “old infection” the doctor didn’t prescribe anything until a violent cough appeared and would not subsist. She was then put on an ICS an inhaler with steroids, I believe for a short time.

We are lost at how to help her. She works with children part-time at a sports facility and has been complaining of joint pain recently. To where it is affecting her work. (I worry that it is a new auto-immune disease.) She follows the doctor’s advice to the letter. She comes home from work/school exhausted. Turns down most of her friend’s invites. We feel she is slowly falling apart.

Thank you Aldous. We will see if there is any changes once we begin this new venture for her. She will not be ending any of the meds prescribed unless that doctor advises.

We, as her parents, want only to see her healthy and well. Neither of us are dealing with any of the issues she has, nor are other family members. I tried conventional doctors, specialists, their tests and the medications. For over a year now. She has tested in the high range for wheat, gluten, casein/cows milk, soy and corn. One doctor asked her if she was autistic. I am not sure why.
I truly don’t know what else we can do for her, but why is she so sick all of the time? What does her future hold for her at this rate?
Didn’t mean to go on and on. I am desperate. I want her back to healthy–maybe something different can help? I don’t know, but I have to try. Thank you.